Provider Demographics
NPI:1699826636
Name:HOMER GLEN OPEN MRI AND IMAGING LLC
Entity Type:Organization
Organization Name:HOMER GLEN OPEN MRI AND IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-301-4664
Mailing Address - Street 1:14833 FOUNDERS XING
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6705
Mailing Address - Country:US
Mailing Address - Phone:708-301-4664
Mailing Address - Fax:
Practice Address - Street 1:14833 FOUNDERS XING
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6705
Practice Address - Country:US
Practice Address - Phone:708-301-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3223Medicare UPIN